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SECTION I - General Information 1.) Agency Location: Rural (Less than 10,000 population) Town (10,000 to 100,000 population) Large Metro (More than 100,000 population) 2.) Agency's 2008 total revenues: 3.) Number of agency principals:  4.) How many full-time equivalent employees are in the agency?       (Be sure to include owners and part-time people.) Management: Sales: Staff: 5.) W-2 payroll and/or 1099 payments as a % revenues for 2008: Owners: % of revenues Non-Owner Producers: % of revenues Non-Owner Mgrs & Staff: % of revenues 6.) 2008 Pretax Profit as % of Revenues:  % 7.) Average Salary/Wage increase for 2009:  % Rate of increase is higher; lower; same in 2009 compared with increase in 2008. 8.) Is there an agency employee incentive bonus plan? Yes No If yes, it is based on: Agency Profits Revenue Growth Increased Productivity Contingents Other (describe): 9.) Do you provide group health insurance? Yes No % paid by agency for employee % paid by agency for dependents 10.) Compare your agency's current group health insurance premium to a year ago:  Premium is lower   Premium is higher   Premium is the same   11.) How is the agency managing any increased cost of the group health insurance?  Agency has absorbed all increasess for its employees   Increased costs have been pass on to the employees   Agency has reduced its group health coverage by decreasing benefits offered to employees   12.) Do you have a retirement plan? IRA/Keough/SEP Deferred Pension Plan ESOP 401(k) % matching for 401(k) Qualified Profit Sharing Plan % of 2008 salaries                  contributed

SECTION II - Service Staff Compensation Indicate the full-time equivalent number of people and full-time 2009 salary range for each of the following positions. Experience (where indicated) refers to any insurance experience in a similar position, either in your agency or elsewhere. If you do not have the described position, leave the item blank. 1.) Personal Lines CSR - Over two years' experience: Number in position: Salary Range: $ to $ 2.) Personal Lines CSR - Two years' experience or less: Number in position: Salary Range: $ to $ 3.) Do Personal Lines CSRs receive additional compensation for selling? Yes No   $ per policy or per account  % of new business commissions % of renewal commissions Other (describe below): 4.) Commercial Lines Service Representative or Underwriter -      Over seven years' experience: Number in position: Salary Range: $ to $ 5.) Commercial Lines Service Representative or Underwriter -      Over two years' but not over seven years' experience: Number in position: Salary Range: $ to $ 6.) Commercial Lines Service Representative or Underwriter -      Two years' experience or less: Number in position: Salary Range: $ to $ 7.) Employee Benefits Service Representative: Number in position: Salary Range: $ to $

SECTION III - Sales Compensation 1.) How are non-owner producers paid? Salary Salary Plus Production Bonus Salary Plus Commissions Straight Commission Salary as Draw Against Commissions 2.) On which factors is the salary portion based? Indicate from 1 (most important) to 5 (least important) Percent of previous year's commissions Percent of anticipated production Management duties Longevity No correlation to production or performance 3.) If commission percentage is used in calculating       compensation, what is the 2009 percentage?   % New % Renewal Personal Lines: Small Commercial: Large Commercial: Group: Life: Handling Other Producer's Accounts: 4.) 2009 compared to 2008, Producer commission %: increased; decreased; or stayed the same. 5.) Referral fee 6.) Expenses paid by agency for producer: Group Insurance Education Business Travel Entertainment Provide Car   Monthly Car Allowance:   $ 7.) What types of employment contracts do you have with your producers? Non-Piracy Non-Complete Non-Solicitation Do not have producers sign employment contracts 8.) Do producers vest in their commissions? Yes No 9.) Indicate the amount of commissions you expect a new commercial producer to have written by the end of 1.5 years with the agency: $

SECTION IV - Management Compensation 1.) Manager's Salaries - Refers to only those people performing full management functions. Do NOT include salespeople who might also have department management as an additional duty.   2009 Salary Level 2008 Bonus President/CEO $ $ Office/Admin. Mgr $ $ Sales Manager $ $ Accounting Mgr/Controller $ $ Personal Lines Manager $ $ Commercial Lines Mgr $ $ Marketing/Underwriting Mgr $ $ IT/Automation Manager $ $ 2.) Management personnel receive these bonuses: Percent of Salary Percent of Agency Revenues Percent of Agency Profits Percent of Department Profits Discretionary No Bonuses Paid SECTION V - Owner's Compensation 1.) Rank from 1 (most important) to 5 (least important) the factors used in determining owners salaries: Existing book of business handled New business written in prior year Percentge of ownership Management Contribution Longevity 2.) Rank from 1 (most important) to 5 (least important) the factors used in determining owners' bonuses: Existing book of business handled New business written in prior year Percentge of ownership Management Contribution Longevity 3.) If a commission percent is used in calculating owner compensation, how does it relate to non-owner producer rates: Same Higher Lower 4.) Does the agency have a formal, written perpetuation plan that does not rely solely on life insurance? Yes No